Overview of SARS-CoV-2 infection in adults living with HIV

Abstract

Around 2·5 million deaths and more than 110 million COVID-19 cases have been reported globally. Although it initially appeared that HIV infection was not a risk factor for COVID-19 or more severe disease, more recent large studies suggest that people living with HIV (particularly with low CD4 cell counts or untreated HIV infection) might have a more severe clinical course than those who are HIV-negative. Moreover, the COVID-19 pandemic has disrupted HIV prevention and treatment services worldwide, creating huge challenges to the continuity of essential activities. We have reviewed the most relevant features of COVID-19 in people living with HIV and highlighted topics where further research is required.

Figure 1

Therapeutic management of COVID-19 in patients with HIV in January, 2021 Adaptive COVID-19 Treatment Trial scores on the ordinal scale: 1=not hospitalised, no limitations of activities; 2=not hospitalised, limitation of activities, home oxygen requirement, or both; 3=hospitalised, not requiring supplemental oxygen and no longer requiring ongoing medical care (used if hospitalisation was extended for infection control reasons); 4=hospitalised, not requiring supplemental oxygen but requiring ongoing medical care (COVID-19-related or other medical conditions); 5=hospitalised, requiring any supplemental oxygen; 6=hospitalised, requiring non-invasive ventilation or use of high-flow oxygen devices; 7=hospitalised, receiving invasive mechanical ventilation or extracorporeal membrane oxygenation; and 8=death. Asymptomatic or presymptomatic infections=individuals positive for SARS-CoV-2 with a virological test (ie, a nucleic acid amplification test or an antigen test), but with no symptoms consistent with COVID-19. Mild illness=individuals with any of the various signs and symptoms of COVID-19 (eg, fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhoea, and loss of taste and smell) but without shortness of breath, dyspnoea, or abnormal chest imaging. Moderate illness=individuals with evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation of 94% or higher in room air at sea level. Severe illness=individuals who have oxygen saturation of less than 94% in room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen of less than 300 mm Hg, respiratory frequency of more than 30 breaths per min, or lung infiltrates of more than 50%. Critical illness=individuals who have respiratory failure, septic shock, or multiple organ dysfunction. Remdesivir is approved by the regulatory agencies (ie, US Food and Drug Administration and European Medicines Agency) but is currently not recommended by WHO for COVID-19 treatment (regardless of HIV status).

Figure 2

Interaction of the HIV and SARS-CoV-2 pandemics and unanswered questions